Provider Demographics
NPI:1235458944
Name:FORD, HENRY LAMONT (MASTER STYLIST)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LAMONT
Last Name:FORD
Suffix:
Gender:M
Credentials:MASTER STYLIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79403-3903
Mailing Address - Country:US
Mailing Address - Phone:806-543-1187
Mailing Address - Fax:806-722-2403
Practice Address - Street 1:2825 50TH ST
Practice Address - Street 2:SUITE 30
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4328
Practice Address - Country:US
Practice Address - Phone:806-543-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194952335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier